Paediatric Dialysis at a Tertiary Hospital in South-West Nigeria: A 4-Year Report.

INTRODUCTION: Dialysis is potentially lifesaving in children with acute kidney injury (AKI) or chronic kidney disease (CKD), but availability is limited in low-income countries and lower-middle-income countries (LMICs). METHODS: In the present study, we perform a 4-year study of patients who received peritoneal dialysis (PD) or haemodialysis (HD) at the Paediatric Nephrology Unit of the University College Hospital Ibadan, Nigeria. Subgroup analysis was performed on patients with sepsis or malaria AKI who underwent HD or PD for predictors of in-hospital mortality. RESULTS: A total of 167 children aged 7 days to 18 years, median 7 (interquartile range 3-12) years, (60.5% males) were studied. In total, 129 (77.2%) had AKI, while 38 had CKD. Regarding AKI, 83 children (64.3%) received HD only, 42 underwent PD only, while 4 underwent both HD and PD. Malaria AKI was treated with HD in 43 (51.8%) or PD in 8 (10.5%), while sepsis AKI was treated with HD in 20 (21.4%) or PD in 33 (78.6%). Mortality in AKI was 16.3% overall, 10.8% in children on HD only, and 26.2% in children on PD only. Patients with sepsis AKI had higher mortality compared to patients with malaria AKI (RR 7.96 [1.70-37.37]). Subgroup analysis showed that age, diagnosis, and dialysis modality were not independent risk factors for mortality. The aetiology of CKD was glomerulonephritis in 26 (68.4%): treatment was HD in 36 and PD in 2 with mortality being 26.3%. CONCLUSIONS: PD for AKI showed relatively good outcomes in a LMIC. However, funding and support for a formal dialysis program for the management of AKI and CKD are needed.

Childhood Nephrotic Syndrome in Africa: Epidemiology, Treatment Trends, and Outcomes.

Nephrotic syndrome is a common childhood glomerular disease that is associated with massive proteinuria and edema. Children with nephrotic syndrome are at risk of chronic kidney disease, disease-related complications, and treatment-related complications. Patients with frequently relapsing disease or steroid toxicity may require newer immunosuppressive medications. However, access to these medications is limited in many African countries owing to prohibitive cost, the need for frequent therapeutic drug monitoring, and a lack of appropriate facilities. This narrative review examines the epidemiology of childhood nephrotic syndrome in Africa, including trends in treatment and patient outcomes. In most of North Africa, as well as among White and Indian populations in South Africa, the epidemiology and treatment of childhood nephrotic syndrome closely resembles that of European and North American populations. Historically, secondary causes of nephrotic syndrome (eg, quartan malaria nephropathy and hepatitis B-associated nephropathy) were predominant among Blacks in Africa. Over time, the proportion of secondary cases has decreased, along with rates of steroid resistance. However, focal segmental glomerulosclerosis increasingly has been reported among patients with steroid resistance. There is a need for consensus guidelines for the management of childhood nephrotic syndrome in Africa. Furthermore, establishing an African nephrotic syndrome registry could facilitate monitoring of disease and treatment trends, and provide opportunities for advocacy and research to improve patient outcomes.

Treatment outcomes of Nigerian patients with tuberculosis: A retrospective 25-year review in a regional medical center.

INTRODUCTION: Tuberculosis (TB) remains a global health challenge and leading infectious killer worldwide. The need for continuous evaluation of TB treatment outcomes becomes more imperative in the midst of a global economic meltdown substantially impacting resource-limited-settings. METHODS: This study retrospectively reviewed 25-years of treatment outcomes in 3,384 patients who were managed for TB at a tertiary hospital in Nigeria. Confirmed TB cases were given directly observed therapy of a short-course treatment regimen and monitored for clinical response. RESULTS: Out of 1,146,560 patients screened, there were 24,330 (2.1%) presumptive and 3,384 (13.9%) confirmed TB cases. The patients' mean age was 35.8 years (0.33-101 years). There were 1,902 (56.2%) male, 332(9.8%) pediatric, and 2,878 (85%) pulmonary TB cases. The annual mean measured treatment outcomes were as follows: adherence, 91.4(±5.8) %; successful outcome, 75.3(±8.8) % potentially unsatisfactory outcome, 14.8(±7.2) %; and mortality 10.0(±3.6) %. Female, extra-pulmonary TB (EPTB), newly diagnosed, and relapsed patients compliant with treatment had successful outcomes. Adulthood and HIV infection were mortality risk factors. CONCLUSION: The mean annual successful treatment outcome is 75.3(±8.8) %. Female, pediatric, EPTB, new, and relapsed patients were predisposed to successful treatment outcomes. Lessons learned will guide future program modifications.

Haemodialysis for paediatric acute kidney injury in a low resource setting: experience from a tertiary hospital in South West Nigeria.

BACKGROUND: Acute kidney injury (AKI) is an important cause of preventable mortality among children. Management of AKI may require renal replacement therapy (RRT) but access to RRT for children in low resource settings is limited. Our study explored the role of haemodialysis in the management of children with AKI in a low resource setting in terms of aetiology and outcomes. METHODS: A review of patients managed in the Paediatric Nephrology Unit, University College Hospital Ibadan, South-West Nigeria, who underwent haemodialysis for AKI from January 2006 to December 2014. RESULTS: Sixty-eight patients (55.9% males), aged 3-16 (mean ± standard deviation, 9.0 ± 3.4) years were studied. The causes of AKI were sepsis (22.1%), malaria (17.6%) and glomerulonephritis (17.6%), intravascular haemolysis-cause unknown (16.2%), G6PDH deficiency (7.4%), malignancy (8.8%) and haemoglobinopathy (5.9%). The number of sessions of haemodialysis ranged from 1 to 10 (mode = 2 sessions) over a period of 1-55 days. Mortality was 27.9% (n = 19) and was related to the aetiology of AKI (P = 0.000): no deaths among patients with intravascular haemolysis or malaria, six deaths among patients with sepsis (40%), six (50%) among the patients with glomerulonephritis, while all the patients with malignancies died. CONCLUSIONS: The outcome of haemodialysis for AKI in Nigeria is relatively good and is related to the underlying aetiology of AKI. In addition to peritoneal dialysis, intermittent haemodialysis may have a role in the management of paediatric AKI in low resource settings and should be supported.